Using In-Shoe Inertial Measurement Unit Sensors to Understand Daily-Life Gait Characteristics in Patients With Distal Radius Fractures During 6 Months of Recovery: Cross-Sectional Study

BACKGROUND

A distal radius fracture (DRF) is a common initial fragility fracture among women in their early postmenopausal period, which is associated with an increased risk of subsequent fractures. Gait assessments are valuable for evaluating fracture risk; inertial measurement units (IMUs) have been widely used to assess gait under free-living conditions. However, little is known about long-term changes in patients with DRF, especially concerning daily-life gait. We hypothesized that, in the long term, the daily-life gait parameters in patients with DRF could enable us to reveal future risk factors for falls and fractures.

OBJECTIVE

This study assessed the spatiotemporal characteristics of patients with DRF at 4 weeks and 6 months of recovery.

METHODS

We recruited 16 women in their postmenopausal period with DRF as their first fragility fracture (mean age 62.3, SD 7.0 years) and 28 matched healthy controls (mean age 65.6, SD 8.0 years). Daily-life gait assessments and physical assessments, such as hand grip strength (HGS), were performed using an in-shoe IMU sensor. Participants' results were compared with those of the control group, and their recovery was assessed for 6 months after the fracture.

RESULTS

In the fracture group, at 4 weeks after DRF, lower foot height in the swing phase (P=.049) and higher variability of stride length (P=.03) were observed, which improved gradually. However, the dorsiflexion angle in the fracture group tended to be lower consistently during 6 months (at 4 weeks: P=.06; during 6 months: P=.07). As for the physical assessments, the fracture group showed lower HGS at all time points (at 4 weeks: P<.001; during 6 months: P=.04), despite significant improvement at 6 months (P<.001).

CONCLUSIONS

With an in-shoe IMU sensor, we discovered the recovery of spatiotemporal gait characteristics 6 months after DRF surgery without the participants' awareness. The consistently unchanged dorsiflexion angle in the swing phase and lower HGS could be associated with fracture risk, implying the high clinical importance of appropriate interventions for patients with DRF to prevent future fractures. These results could be applied to a screening tool for evaluating the risk of falls and fractures, which may contribute to constructing a new health care system using wearable devices in the near future.

When and how much does the muscle strength recover after arthroscopic superior capsular reconstruction?

BACKGROUND

Recently, arthroscopic superior capsular reconstruction (SCR) has been performed for irreparable large to massive rotator cuff tears and excellent clinical results have been reported. Although the muscle strength is reported to recover, it has not yet been clarified when and how much it recovers. The purpose of this study was to determine the recovery pattern of muscle strength after SCR.

METHODS

We retrospectively reviewed 35 patients (mean age, 65 years) who met the following inclusion criteria: (1) patients with large to massive irreparable tears of the rotator cuff including the supraspinatus and infraspinatus tendons; (2) those with severe muscle atrophy and fatty change; (3) those who underwent assessment of muscle quality and strength by magnetic resonance imaging and dynamometry at 6 months, 1 year, and 2 years; (4) those with a minimum follow-up period of 2 years; and (5) those without severe osteoarthritis. The isometric muscle strength of scaption (ie, scapular-plane elevation), internal rotation, and external rotation in adduction was measured twice for each motion by a dynamometer.

RESULTS

Relative to the muscle strength on the uninvolved side, the involved side showed 61% ± 21% in scaption, 63% ± 20% in external rotation, and 103% ± 29% in internal rotation at 2 years after surgery. Whereas no significant differences were observed between the 1-year and 2-year follow-up assessments, a significant difference in muscle strength of scaption was found between 6 months and 1 year (P = .0174). Graft retear was seen in 5 cases (14%). There was a trend that the muscle strength of scaption and external rotation in the no-retear group was greater than that in the retear group despite no significant difference (P = .0717 and P = .0824, respectively).

CONCLUSION

The recovery of the muscle strength after SCR was observed until 1 year after surgery, and the muscle strength of scaption and external rotation returned to 60% of that on the uninvolved side at 2 years.

Signaling pathways regulated by natural active ingredients in the fight against exercise fatigue-a review

Exercise fatigue is a normal protective mechanism of the body. However, long-term fatigue hinders normal metabolism and exercise capacity. The generation and recovery from exercise fatigue involves alterations in multiple signaling pathways, mainly AMPK, PI3K/Akt, Nrf2/ARE, NF-κB, PINK1/Parkin, and BDNF/TrkB, as well as MAPK signaling pathways that mediate energy supply, reduction of metabolites, oxidative stress homeostasis, muscle fiber type switching, and central protective effects. In recent studies, a rich variety of natural active ingredients have been identified in traditional Chinese medicines and plant extracts with anti-fatigue effects, opening up the field of research in new anti-fatigue drugs. In this review we give an overview of the signaling pathways associated with the activity of natural food active ingredients against exercise fatigue. Such a comprehensive review is necessary to understand the potential of these materials as preventive measures and treatments of exercise fatigue. We expect the findings highlighted and discussed here will help guide the development of new health products and provide a theoretical and scientific basis for future research on exercise fatigue.

COVID-19 olfactory dysfunction, evaluation of onset, and persistence

Olfactory dysfunction (OD) is a common feature of COVID-19. The goal of the study was to define the modes of onset of OD in the clinical course of the disease and to follow the cases for 12-18 months in order to estimate the differences in the recovery time from OD over the course of the disease. We managed to follow a total of 325 patients (females: 198, males: 127) in the Babylon governorate in Iraq. All were COVID-19 patients who should have OD during the course of the disease. COVID-19 infection was established in all patients by swab test, i.e. polymerase chain reaction (PCR) and/or chest computed tomography findings of pneumonia compatible with COVID-19. Detailed medical records were obtained directly from the patients or their relatives. The patients were then followed up by telephone and questioned with structured questionnaires concentrating upon general clinical features and the sense of olfaction. Information about the presence of olfactory disorders, their occurrence, and development was recorded. Based on the onset of OD, the patients were categorized into three groups. Olfactory functions were assessed primarily by face-to-face interview and then (if necessary) by a telephone questionnaire assessing self-reported olfactory function and olfactory-related quality of life, which measures the subjective olfactory capability (SOC). In the first 2 weeks, 148 (45.5%) patients reported complete recovery from OD, of which 90 (73.2%) patients joined at the end of the 1st month. OD persistence was observed in 11 (3.3%) patients toward the end of the 1st year, in 5 (1.5%) patients at the end of the 15th month, and only in two (0.6%) patients at the end of the 18th month. We found no significant correlation between the type of onset of OD and the duration and persistence of OD. Most sufferers of COVID-associated OD recover their sense of smell within the 1st month.

Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative

Although most individuals recover from acute SARS-CoV-2 infection, a significant number continue to suffer from Post-Acute Sequelae of SARS-CoV-2 (PASC), including the unexplained symptoms that are frequently referred to as long COVID, which could last for weeks, months, or even years after the acute phase of illness. The National Institutes of Health is currently funding large multi-center research programs as part of its Researching COVID to Enhance Recover (RECOVER) initiative to understand why some individuals do not recover fully from COVID-19. Several ongoing pathobiology studies have provided clues to potential mechanisms contributing to this condition. These include persistence of SARS-CoV-2 antigen and/or genetic material, immune dysregulation, reactivation of other latent viral infections, microvascular dysfunction, and gut dysbiosis, among others. Although our understanding of the causes of long COVID remains incomplete, these early pathophysiologic studies suggest biological pathways that could be targeted in therapeutic trials that aim to ameliorate symptoms. Repurposed medicines and novel therapeutics deserve formal testing in clinical trial settings prior to adoption. While we endorse clinical trials, especially those that prioritize inclusion of the diverse populations most affected by COVID-19 and long COVID, we discourage off-label experimentation in uncontrolled and/or unsupervised settings. Here, we review ongoing, planned, and potential future therapeutic interventions for long COVID based on the current understanding of the pathobiological processes underlying this condition. We focus on clinical, pharmacological, and feasibility data, with the goal of informing future interventional research studies.

Evaluation of Blood Biochemistry and Cardiopulmonary status of Hospitalized Covid-19 Patients in 3 Months Post Discharged Follow up Survey

BACKGROUND

The new coronavirus causes systemic inflammation and damage to various organs. So, this study aimed to follow up patients with COVID -19 after recovery for three months by performing cardiac, pulmonary and laboratory tests.

MATERIALS AND METHODS

This was a prospective cohort study of COVID-19 patients who were discharged from Baharloo Hospital. The diagnosis of COVID-19 was confirmed by PCR or long CT scan. Inclusion criteria were age over 18 years and patients with more than 50% of pulmonary involvement in lung CT scan. The patients were called to Baharloo hospital three months after recovery and were examined for cardiac, pulmonary and blood tests.

RESULT

Our study included 178 participants with mean age of 55.70, and 50.6% of them were male. Among pulmonary factors in the hospital, 71.9%, 15.7%,1.7%,19.1% and 53.4% had positive GGO, consolidation, reverse halo sign, traction bronchiectasis and vascular enlargement, respectively. After three months follow up, percentage of patients who had reticulation, honeycombing, fibrotic brand and bullae were 12%, 1.1%,8.4% and 0%, respectively. The Mean values of FVC and FEV1 were reported 4.21 and 3.01, respectively. Among Cardiac factors, positive PVC, PAC and mean Pap were decreased after three months. Only Growth in myalgia and Decreased sense of taste were statistically significant. Also, D dimer, UA protein, PMN, Ferritin CRP, PMN, LDH and HB amounts had decreased significantly.

CONCLUSION

Our study indicated that in addition to pulmonary changes, rapid damage to other organs and the occurrence of cardiac symptoms and changes in laboratory result were also reported in patients recovered from COVID-19.

COVID-19: Is reinfection possible?

The COVID-19 pandemic has spread rapidly in many countries, overburdening health systems and causing numerous economic and social impacts. Most studies on the subject have focused on epidemiology, diagnosis, and treatment, however, there remains a scientific gap concerning the possibility of reinfection. The purpose of this bibliographic review is to gather information from studies aimed at this possibility, and to clarify what we know so far. It was found that in many situations cured patients are being released from hospitals, however, in some cases, the discharge criteria are not effective. Patients are presenting positive RT-PCR tests. There are several factors that might interfere so that patients cured of COVID-19 continue to test positive, and this would not necessarily represent a case of recurrence, as the test cannot differentiate the viral RNA from the complete virus, which alone is capable of causing the active infection. This review demonstrates that in order to rule out the possibility of COVID-19 reinfection in cured patients, more robust methods need to be adopted as criteria for both clinical discharge and post-hospital follow-up.

Recovery of Li(Ni0.33Mn0.33Co0.33)O₂ from Lithium-Ion Battery Cathodes: Aspects of Degradation

Nickel⁻manganese⁻cobalt oxides, with LiNi_0.33Mn_0.33Co_0.33O₂ (NMC) as the most prominent compound, are state-of-the-art cathode materials for lithium-ion batteries in electric vehicles. The growing market for electro mobility has led to a growing global demand for Li, Co, Ni, and Mn, making spent lithium-ion batteries a valuable secondary resource. Going forward, energy- and resource-inefficient pyrometallurgical and hydrometallurgical recycling strategies must be avoided. We presented an approach to recover NMC particles from spent lithium-ion battery cathodes while preserving their chemical and morphological properties, with a minimal use of chemicals. The key task was the separation of the cathode coating layer consisting of NMC, an organic binder, and carbon black, from the Al substrate foil. This can be performed in water under strong agitation to support the slow detachment process. However, the contact of the NMC cathode with water leads to a release of Li⁺ ions and a fast increase in the pH. Unwanted side reactions may occur as the Al substrate foil starts to dissolve and Al(OH)₃ precipitates on the NMC. These side reactions are avoided using pH-adjusted solutions with sufficiently high buffer capacities to separate the coating layer from the Al substrate, without precipitations and without degradation of the NMC particles.

RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting

BACKGROUND/AIM

We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets.

METHODS

Speech-language pathologists or occupational therapists identified patients with stroke and communication, fine motor, or cognitive/perceptual deficits. Patients were provided with iPads individually programmed with applications based on assessment results, and instructed to use it at least 1 h/day. At discharge, patients completed a 19-question quantitative and open-ended engagement survey addressing intervention timing, mobile device/apps, recovery goals, and therapy duration.

RESULTS

Over a six-month period, we enrolled 33 participants (three did not complete the survey). Median time from stroke to initiation of tablet-based therapy was six days. Patients engaged in therapy on average 59.6 min/day and preferred communication and hand function therapies. Most patients (63.3%) agreed that therapy was commenced at a reasonable time, although half expressed an interest in starting sooner, 66.7% reported that using the device 1 h/day was enough, 64.3% would use it after discharge, and 60.7% would use it for eight weeks. Sixty-seven percent of patients expressed a need for family/friend/caregiver to help them use it.

CONCLUSION

Our results suggest that stroke patients are interested in mobile tablet-based therapy in acute care. Patients in the acute setting prefer to focus on communication and hand therapies, are willing to begin within days of their stroke and may require assistance with the tablets.

THE EFFECTS OF MIGRATORY FLIGHT ON HEMATOLOGIC PARAMETERS IN NORTHERN BALD IBISES ( GERONTICUS EREMITA)

Under the project of "Human-Led Migration," the authors had the unique opportunity to accompany hand-raised northern bald Iibises (NBIs; Geronticus eremita) during migration, which occurred in stages from Bavaria, Germany, to southern Tuscany, Italy. The aim of this study was to investigate the immediate effects of flight, with respect to flight duration, and the more delayed recovery effects on hematologic variables. A total of 31 birds were sampled. Blood samples were taken immediately before takeoff, after landing, and 1 day after the flight. Hematocrit was determined and blood smears were prepared to estimate the total white blood count (tWBC) with leukocyte concentrations (absolute [abs.]) and differential blood cell count (%). Postflight, significant decreases in hematocrit, tWBC, lymphocytes (abs., %), heterophils (abs.), eosinophils (abs., %), and monocytes (abs.) were observed. In contrast, heterophils (%), basophils (%), and the heterophil/lymphocyte (H/L) ratio increased significantly. With increasing flight duration, the H/L ratio increased further. One day postflight, there were still significant decreases in tWBC, lymphocytes (abs.), and eosinophils (abs., %) and significant increases in heterophils (%) and the H/L ratio. The hematocrit dropped even further. These data show that the decrease of tWBC is mainly caused by the lymphocyte fraction and that NBIs need more than 1 day to reverse the postflight changes in some hematologic values. Hematocrit changes postflight and on the recovery day are most likely to be explained by hemodynamics and the metabolic and hormonal changes caused by flight. The hematologic changes postflight in NBIs were largely consistent with those of other birds, but they differed from humans and mammals postexercise mainly in the levels of tWBC, heterophils (matching neutrophils in mammals), and lymphocytes.

Proteomic changes of CD4+/CD25+/forkhead box p3+ regulatory T cells in a 30-day rat model of sepsis survival

Sepsis is defined as life threatening organ dysfunction arising from a dysregulated host response to infection. The outcomes of sepsis include early mortality, delayed mortality and recovery, and depend on the inflammatory response. Previous studies have demonstrated that regulatory T cells (Tregs) are important in determining the outcome of sepsis, as their suppressive function serves a role in maintaining immune homeostasis. However, Treg-mediated immunosuppression during the course of sepsis remains unclear and little is known about the survival of patients following diagnosis. Studying the survivors of sepsis may explain the mechanisms of natural recovery. Therefore, a 30-day rat model of sepsis survival was established in the current study. Cluster of differentiation CD4⁺/CD25⁺/forkhead box p3⁺ Tregs were isolated from the blood and spleens of rats undergoing cecal ligation and puncture or sham surgery, using flow cytometry. Proteomic analysis was performed using nano high-performance liquid chromatography-mass spectrometry. Several different biological pathways associated with uncommon differentially-expressed proteins were identified in the blood and spleen survivor and sham groups. Extracellular-regulated kinase/mitogen-activated protein kinase, as well as integrin and actin cytoskeletal pathway elements, including Ras-related protein 1b, talin 1 and filamin A, were associated with Tregs in the blood. Pathway elements associated with cell cycle regulators in the B-cell translocation gene family of proteins, tumor necrosis factor receptor superfamily member 4, Hippo signaling, P70-S6 kinase 1, phosphatidylinositol 3-kinase/protein kinase B signaling and 1,25-dihydroxyvitamin D3 biosynthesis were associated with Tregs from the spleen including phosphatase 2A activator regulatory factor 4, histone arginine methyltransferase, CD4, major histocompatibility complex class I antigens, 14-3-3 protein θ and nicotinamide adenine dinucleotide phosphate cytochrome P450 reductase. These results explain the mechanism by which Tregs naturally recover and indicates that Tregs in the blood and spleen vary. Differentially-expressed proteins serving a role in these pathways provide additional insight for the identification of new targets for the diagnosis and treatment of sepsis.

Who to Refer for Speech Therapy at 4 Years of Age Versus Who to "Watch and Wait"?

OBJECTIVE

To examine predictors of speech disorder resolution versus persistence at age 7 years in children with speech errors at age 4 years.

STUDY DESIGN

Participants were drawn from a longitudinal, community cohort. Assessment at age 4 years (N?=?1494) identified children with speech errors. Reassessment at age 7 years allowed categorization into resolved or persistent categories. Logistic regression examined predictors of speech outcome, including family history, sex, socioeconomic status, nonverbal intelligence, and speech error type (delay vs disorder).

RESULTS

At age 7 years, persistent errors were seen in over 40% of children who had errors at age 4 years. Speech symptomatology was the only significant predictor of outcome (P?=?.02). Children with disordered errors at age 4 years were twice as likely to have poor speech outcomes at age 7 years compared with those with delayed errors.

CONCLUSIONS

Children with speech delay at age 4 years seem more likely to resolve, and this might justify a "watch and wait" approach. In contrast, those with speech disorder at age 4 years appear to be at greater risk for persistent difficulties, and could be prioritized for therapy to offset long-term impacts.

Factors predicting recovery from suicide in attempted suicide patients

AIMS AND OBJECTIVES

The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide.

BACKGROUND

The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery.

DESIGN

A cross-sectional design was adopted.

METHODS

A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis.

RESULTS

The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p < .001) and Brief Symptom Rating Scale-5 (ß = -.218, p = .003) and past suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance.

CONCLUSIONS

Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts.

RELEVANCE TO CLINICAL PRACTICE

The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide.

Separation of soybean saponins from soybean meal by a technology of foam fractionation and resin adsorption

Foam fractionation and resin adsorption were used to recover soybean saponins from the industrial residue of soybean meal. First, a two-stage foam fractionation technology was studied for concentrating soybean saponins from the leaching liquor. Subsequently, resin adsorption was used to purify soybean saponins from the foamate in foam fractionation. The results showed that the enrichment ratio, the recovery percentage, and the purity of soybean saponins by using the two-stage foam fractionation technology could reach 4.45, 74%, and 67%, respectively. After resin adsorption and desorption, the purity of soybean saponins in the freeze-dried powder from the desorption solution was 88.4%.

γ-Secretase inhibitor reverts the Notch signaling attenuation of osteogenic differentiation in aged bone marrow mesenchymal stem cells

The age-related changes in cell viability and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) play pivotal roles in the fracture healing process, especially in geriatric individuals. This study was designed to explore the age-related changes in murine BMSCs and the regulation of osteogenic differentiation in aged BMSCs in vitro. Notch signaling pathway took part in the regulation of osteogensis, while the relationship between Notch and the osteogenic differentiation in aged BMSCs has not been reported yet. BMSCs harvested from the bone marrow of young, adult, and aged C57BL/6 mice were cultured in osteogenic and adipogenic differentiation media. Histochemical staining results indicated that the osteogenic ability of BMSCs gradually decreased with aging, whereas the adipogenic ability increased. Cell activity assays showed that the proliferative and migrated capacity did not decline with aging significantly. According to real-time PCR and Western blotting results, the aged cells exhibited higher Notch signaling expression level than the younger ones did. After the aged BMSCs being treated with γ-secretase inhibitor, however, Notch activity was changed and the aging-imparied osteogenic ability reverted to a normal level. This study demonstrated that the decreased bone formation capacity in aged BMSCs had relationship with the transdifferentiation between osteogenesis and adipogenesis, which would be regulated by Notch signaling pathway and the attenuated osteogenesis in aged BMSCs could be promoted when the inhibition of Notch pathway.